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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE A DRESS PARCEL TAX I.D. # PERMIT # <br />- 7 G',e I Oo I <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />cam. �C:G;C IL t L ( er P)Aj (L <br />_ <br />TENANT NAME ` CONTACT FOR PERMIT I PHONE <br />po4lesrlL t/(o(evczs�'{✓r�Pb <br />t)� SA/ytictsi <h CO[IA"f r I E-MAIL <br />�V T R DDRES CITY/ZIP PHONE <br />CONTR. LICENSE # 4� EA 11(15,10 lY^ A / <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�(//V <br />,1 Electric —Gas _ Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />,X <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />_ <br />Backflow preventer <br />_ <br />Heal pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />_ <br />Roof mains <br />_ <br />Other _ <br />fi O <br />Other-d <br />1'U90wL' <br />r E'r✓Cy -t7'0 l /I Oi:it'60 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />I hereby certify that I have read and examined this application �.nd know the same to be true and correct. All provisions of law <br />ordinances goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not, _ume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Sla a Contractors aw 18.27 RCW and 296.200 WAC. <br />� �� /-/2 <br />Signature of Owner/Contactor/Authorized Agent Dale <br />